Table health department quick fix

It's one thing to improve the way a state agency does business. It's quite another to seek passage of a major overhaul without sufficient vetting and inspection. That's the issue we take with a bill to overhaul the Florida Department of Health.

Tallahassee lawmakers had barely shelved one huge piece of legislation — the much talked about gambling bills — when state Rep. Matt Hudson, R-Naples, unveiled HB 1263, a 152-page bill that would decentralize the state health agency by transferring the bulk of its functions to the 67 county health departments. Some key services could simply disappear, part of an effort Hudson characterized as ridding the department of duplicative programs and obsolete services.

What would result would be a leaner, and perhaps, and more efficient public health system. The new department would allocate block grants to the county health departments on a per capita basis and the county-run health departments would focus primarily on communicable disease control, environmental health and primary health care services.

That much seems appealing.

But the bill proposes more than simple decentralization. It shifts the responsibilities of a major state agency on to county governments — many of which simply aren't equipped to handle the complexities and the costs of providing public health services. How all this will work is anyone's guess, and that alone is reason enough for lawmakers to require more time to sort through what's at stake.

To be upfront, we worry the measure could put large county health departments, like those in South Florida, at a disadvantage. Typically, urban county health departments have large investments in infectious disease control, case management services for at-risk residents, community coordination and networking, as hospitals provide front-line medical services. What happens to those efforts under this legislation? For that matter, the bill doesn't put much emphasis on environmental health, either, since most residents in urban communities are on city or county-run sewer and water systems.

There are other concerns that will take more time to resolve than the time left in this year's 60-day legislative session.

DOH, for example, currently has a statewide system to bill Medicaid and register patients. How easy would it be for all 67 counties to adopt a similar and consistent system in a decentralized operation?

What happens to the estimated 12,000 DOH employees who will have to find work in the county health departments, and how realistic is it to expect the department to complete its transition into a county-centered decentralized system in what remains a tight timeline?

The bill also calls for the closing of A.G. Holley State Hospital, one of the nation's four active tuberculosis hospitals. The move will save money, but the proposed change comes as medical officials are growing concerned about new strains of this enduring disease.

There may be many viable ways to address the ongoing problems of bureaucracy in the health department, and in time the appropriate and positive answers will come about. The goal is to improve the efficiency and effectiveness of Florida's public health system. We just don't think it should be done through this bill in the mere weeks left in this session.